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Choosing wisely and delivering value in obstetrics and gynecology

Neel Shah, MD

Physician

June 12, 2013

The pressure on physicians to provide better care at lower costs is coming from all directions – top down from policymakers who want more accountability in how healthcare resources are being used and bottom up from patients who want more transparency in how their money is being spent. Obstetrician and gynecologists have not been spared any scrutiny. As primary care providers for many women we are in thick of the …

Apps to help manage medications in the elderly: What I’m looking for

Leslie Kernisan, MD, MPH

Health Technology

June 11, 2013

I’ve been interested in apps for the caregivers of elders, but like many physicians, I’ve been too busy to seriously research them or try them out.

Time to change that. No, I’m not going to exhaustively research and review all caregiver apps on the market.

But, as I’ve been invited to give a technology talk to a local group of family caregivers later this summer, I would like to see if I …

In praise of Kangaroo care for premature infants

Jennifer Gunter, MD

Conditions and Diseases

June 11, 2013

Kangaroo care (KC) is the practice of skin-to-skin contact with a premature baby and parent. In low and middle-income countries, where there are fewer medical resources, Kangaroo care has been shown to reduce mortality among premature babies and shorten the length of hospital stay.

Kangaroo care is also very beneficial in high-income countries even in the midst of extremely high-tech care.

Holding a premature baby skin-to-skin:

Improves breast milk production and breastfeeding (when mothers …
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In praise of Kangaroo care for premature infants

Being a plastic surgeon requires a lot of explaining

Peter Neligan, MD

Physician

June 11, 2013

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A new crop of medical students will begin a residency in plastic surgery this summer. They have worked long and hard to secure these coveted spots. As a service to them and the profession, I wanted to take this opportunity to help make their path a little easier by offering a bit of advice.

When asked what you do, simply say that …

A psychiatric disorder or a profound lack of discipline in our kids?

Greg Smith, MD

Physician

June 11, 2013

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It is hard to see a child in pain.

I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago.

Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training provided me with didactic …

Why the days of medical privacy are over

Dinah Miller, MD

Physician

June 11, 2013

I’m lucky, I work for one of the best hospitals in the country and I have access to the best medical care that our society has to offer. With one glitch, that is — when I access that care, my medical records are put into a system that can be viewed by thousands of people, some of whom include my bosses, co-workers, supervisees, neighbors, and even some of my patients.

I …

A natural death: What exactly does that mean?

Alex Smith, MD

Physician

June 11, 2013

What is a natural death, anyway?

I get it – death is part of the cycle of life. Seasons change. The moon waxes and wanes. We are born. We die. Death is natural.

But what is a “natural” death? Seriously, what comes to mind when you think of natural death? Here is a video of a natural death, taken from the Planet Earth series:

Death in nature is often violent, brutal, …

Why surgical instruments are the way they are

Sid Schwab, MD

Physician

June 10, 2013

Next in a continuing series.

There’s a reason for the cliche — surgeon barks out the name of an instrument, scrub nurse whacks it into the hand. The reason is this: when you are focused on a particular area — especially if it’s one in which danger lies — you don’t want to look away. If you need to change …

The dual narratives that define health reform

Wes Fisher, MD

Health Policy

June 10, 2013

Doctors are trying to rationalize our current story line: the loss of autonomy and pay cuts are a necessary evil for the greater good. We’re taking one for the excess-health care cost team. We’re willing to take this personal sacrifice for our fellow man and woman. It is the noble thing to do. It will be good for America’s healthcare system if we do our part, work harder …

Grilling with aluminum foil: What are the health risks?

Dr. Charles

Conditions and Diseases

June 10, 2013

As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …

Ask patients if they feel comfortable asking questions

Kevin R. Campbell, MD

Physician

June 10, 2013

Let me start by saying that I am by no means an expert in medical oncology and I have great respect for what my colleagues in this field are able to do for their patients and their families.

From my earliest days of internal medicine training at the University of Virginia, I can remember the oncologists as being some of the most caring and compassionate physicians around. However, recently I came …

Entitled patients: 6 ways to respond

Susan Keane Baker

Patient

June 10, 2013

You probably know patients who present with entitled attitudes and you may think there’s not much you can do about them. Entitled patients often demand excessive attention and may question your competence when they are not satisfied with how important you make them feel.

By using one or more of the following approaches, you can manage entitled patients respectfully while reducing your risk of stress and burnout.

1. Be on the same …

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Entitled patients: 6 ways to respond

Looking up health information online: Do you really trust your doctor?

James C. Salwitz, MD

Physician

June 10, 2013

Physicians are bothered by their patient’s fear. One of the worst parts of actually caring is that when other people suffer and especially when they are frightened, you suffer with them. It is bad when the trepidation is about something real, such as a new disease, but it is particularly disturbing when the source of the fear is confusion or bad information.

There are several common sources of inaccurate terrifying data. …

Physicians gain unique insights when they become ill themselves

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

June 9, 2013

As physicians, we are all privileged to share with our patients the experience of illness, helping to inform and guide. When we as physicians become ill ourselves, we face unique challenges and gain unique insights. This column will explore those dimensions of experience, when doctors become patients.

We recently spoke with Robert S. Brown, MD, FACP, associate professor of medicine at Harvard Medical School and attending nephrologist at Beth Israel Deaconess …

Responding to patient concerns after changing my practice

Jordan Grumet, MD

Physician

June 9, 2013

Below find excerpts of an email sent by a faithful reader. I have included the whole text, but broken it down to respond to each point accordingly.

I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.

I have been waiting for this. Expecting it. I knew …

Recognizing the signs and symptoms of stroke in children

Veronica Szalkowski-Lehane, MD

Conditions and Diseases

June 9, 2013

When we think of strokes, we imagine older adults. Yet, one out of every 2,800 newborns (under 1-month) suffers a stroke. In children up to 18, it occurs in 11 out of 100,000. I know how serious this can be – my daughter experienced a stroke before birth. The day before she was born, we discovered she had hydrocephalus (water on the brain). When she was a day old, an …

Does patient engagement set patients up for failure?

Jessie Gruman, PhD

Patient

June 9, 2013

“Maybe we shouldn’t urge people to engage in their health care: it sets them up for failure and punishment from their clinicians.”

A senior patient advocate and researcher recently made this comment to a gathering of experts in patient engagement.

For a few minutes, I was inclined to agree with her. I thought back over the previous three months: the passive aggressive (and aggressive-aggressive) responses of some of my clinicians to my …

Why setting consistent boundaries is important

Alex Lickerman, MD

Conditions and Diseases

June 9, 2013

A few weeks ago my wife, my son, and I went out for dinner. My son, though usually well-behaved and pleasant, was boisterous and disruptive, alternately leaping off his seat to crawl under the table and banging his silverware on his water glass to see what different volume of sound he could make it produce. Our tolerance for disciplining him patiently having been exhausted in us both by our respective challenging …

How to know if your baby has autism

Naline Lai, MD and Julie Kardos, MD

Conditions and Diseases

June 8, 2013

Autism is a communication disorder where children have difficulty relating to other people. Pediatricians watch for speech delay as a sign of autism. Even before your child is expected to start talking, around a year old, you can watch for communication milestones. Problems attaining these milestones may indicate autism or other disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays.

By six weeks of age, your …

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How to know if your baby has autism

It is not feasible for a provider to be expert in everything

Patrice Wade, DNP

Conditions and Diseases

June 8, 2013

Since I’ve always had an interest in food and nutrition, as a young nurse and student, I just assumed that all health care providers assessed nutrition. After all, we know how important it is. However, as a staff nurse in the ER and a nurse practitioner doctoral student, I learned that wasn’t true. Many providers in both arenas reported it was not the priority that medication and disease management were.

Throughout …

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